04D2202764 CLIA NUMBER - SHERIDAN FAMILY CLINIC

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Laboratory Demographics

CLIA Number: 04D2202764

Facility Name: SHERIDAN FAMILY CLINIC

Facility Address:
109 W PINE ST STE A
SHERIDAN, AR
ZIP 72150
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Facility Phone Number: 870 917-5572

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1275134603

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2202764
LAB Type	Practitioner Other
Facility Name	SHERIDAN FAMILY CLINIC
Street	109 W PINE ST STE A
City	SHERIDAN
State	AR
ZIP	72150
Phone	870 917-5572
CertificateType	4
CertificateEffectiveDate	12/1/2022
CertificateExpirationDate	11/30/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024